Application for grant or renewal of a loan licence to manufacture for
sale 76a[or for distribution of drugs
other than those specified in 78[Schedules C, C(1)
and X]

1.
I/We* .of+ .
hereby apply for the grant/renewal of a loan licence to manufacture on the premises
situated at .C/o++
. the under mentioned drugs, other than those
specified in 78[Schedules C, C(1)
and X] to the Drugs and Cosmetics Rules.

Names of drugs (each substance to be separately specified).

2. The names, qualifications and experience of the expert staff
actually connected with the manufacture and testing of the specified products in the
manufacturing premises.

3. I/We enclose

(a) A true copy of a letter from me/us to the manufacturing
concern whose manufacturing capacity is intended to be utilised by me/us.

(b) A true copy of a letter from the manufacturing concern that
they, agree to lend the services of their expert staff, equipment and premises for the
Manufacture of each item required by me/us and that they will analyse every batch of
finished product and maintain the registers of raw materials, finished products and
reports of analysis separately in this behalf.

(c) Specimens of labels, cartons of the products proposed to be
manufactured.

4. A fee of rupees . has been
credited to Government under the head of account
.

Date . Signature .

* Enter here the name of the proprietor, partners or Managing Director
as the case may be.

+ Enter here the name of the applicant firm and the address of the
principal place of business

++ Enter here the name and address of the manufacturing concern where
the manufacture will be actually carried out and also the Licence number under which the
latter operates.